The Norman Transcript

October 9, 2012

Dismal care outcomes, causes and cures

By Jesse Fuchs
The Norman Transcript

NORMAN — A claim commonly made from time to time by politicians of major political parties, current health system apologists and defenders, is that, “America has the best health care in the world.” This boastful claim may be an excellent example of national pride and spirit. However, it is totally unsupported by our country’s demographic and health care outcome statistics and by our medical per capita cost when compared to those of other world countries.

Quite the contrary — as evidenced by the commonly used health outcome statistics of life expectancy, infant mortality, maternal mortality and healthy life expectancy — we have one of the worst health care outcomes of all modern countries and even worse than those of some developing countries. Our medical cost per capita is also the largest in the world. 

Of these five health system quality measures, let us first look at life expectancy. The CIA 2012 WorldFact Book ranks the U.S. as 50th in descending high to low life expectancy, among 221 reporting countries and territories. On average, the citizens of 11 countries live more than three years longer, and the citizens in six nations live on average more than four years longer than U.S. citizens. In an additional 12th country of Canada, the citizens under their oft-labeled “socialist” medical system on average live a tiny fraction just short of three or 2.99 years longer than U.S. citizens.

Let’s take a look at three other health system quality measures.

The World Health Organization reports comparative health statistics for 180 to over 190 countries and territories. In their most recent statistics available, WHO ranks the U.S. as 29th in descending high to low healthy life expectancy, which is defined as one’s average expected active years of life spent without major health problems. The U.S. is ranked 49th in ascending low to high in infant mortality.

Most embarrassing of all, according to WHO statistics, the U.S. also is ranked 49th in ascending low to high in maternal mortality, behind the much less modern countries of Iran, Turkey, Serbia, Puerto Rico and Slovenia. This means that U.S. women who experience child birth die more often due to childbirth complications than women in 48 other countries, including these five relatively poorer countries.

The remaining health system quality measure is perhaps most revealing of all. What is our comparative cost for our system that results in these very poor health care outcomes? 

In a world country comparison of medical cost per capita, WHO ranks the U.S. as No. 1 in descending high to low in health expenditures. The U.S. annually spends $8,362 per person. Of the countries that have much better health outcomes than the U.S., all spend less — most of these much less — with many of the same spending a small fraction of what the U.S. spends per capita.

It also important to note that of the 49 nations that have better health outcomes than the U.S., all but one country obtain their better health outcome results by having the larger portion of their health care expenditures as governmental expenditures. Singapore is the exception.

In other words: Excepting Singapore, all world countries that exceed the U.S. in health care outcomes also have a health system of which a major portion is composed of a government health care plan. Universal coverage or near universal coverage appears to be the best explanatory key to the obtainment of good health care outcomes.

I understand that Singapore achieves this with mandatory health insurance for employers. However, the economical way that almost all of these countries achieve this and obtain their excellent health are outcomes is through having predominately government health insurance plans.

Considering that so many nations achieve better health outcomes than we do and do it much more economically, almost all using government health care plans, why don’t we fully examine their systems’ successes and failures and create a system of health care that works for all U.S. citizens and not just those who can afford it or happen to be lucky enough to have an employer who provides economic, quality health care coverage for its employees, this latter becoming very rare in the U.S.?

I believe the answer to this can be found in an investigation of the tremendous amounts of money made in the current for-profit system and the sources and huge amounts spent in related political funding and in relevant public health opinion campaigns against reform. 

According to the Wall Street Journal and other newspapers, the major health insurance companies continue to make record profits and are paying tens of millions of dollars in bonuses to their CEOs. For example, Aetna reported first-quarter profits of $250 million. As a consequence, opposition to health care reform is well financed.

The nonprofit and non-partisan citizens’ group is the most comprehensive resource for federal campaign contributions, lobbying data and analysis available anywhere. They report that over a half a billion dollars are given or spent each election cycle by the combined health industry, in the form of political campaign donations and advertisements aversive to health care reform. 

These huge expenditures made by and on behalf of maintaining our present for-profit health system, have been hugely successful in facilitating the election of anti-health care reform politicians and resulted in a thoroughly misinformed public, concerning health care issues. The non-partisan and non-profit PolitiFact group has 35 webpages listing misinformation that is currently being propagated and circulated concerning health care reform.

They report eight of the worse recent “pants on fire’ lies as the following: It finances abortion, it did and still contains death panels, it will end Medicare as we know it, it will end our present employer plans, it will cost 20 million jobs, it is the biggest tax increase ever and it amounts to a complete government take-over — all complete lies and fabrications but, sadly, commonly believed.

Our country and its citizens pay a huge price for not reforming our present for-profit and broken health system. U.S. News and others news sources report sharply rising medical costs, meaning that our employer-based plans are becoming increasingly more expensive, have increasing higher co-payments and are paying increasingly less for medical procedures.

American companies are less competitive in the global market, largely due to our high health care costs and increased health care costs in our associated archaic employer-based workers compensation system. It is not commonly known, or it is misunderstood by most citizens, that American workers are paid significantly less than their counterparts in other modern-world countries. This pay difference is primarily due to the same reason — the exorbitant health care costs for their employers.

Our doctors are currently crushed by rising malpractice insurance costs. Such costs are not faced by their counterparts in countries with government-based health systems. So-called tort reform only modifies the symptoms, while creating injustices and other problems. Our older workers are finding difficulty retaining and regaining employment, due to employers’ reluctance to shoulder the greater risk that older workers might have for health-related problems. Older citizens in other countries do not face this problem, or at least not for this same reason.

It is not my contention that our current health care reform law will solve most of the above problems, being that it consists mainly of items that are warmed-over versions of 1990s Republican health care proposals and of Mitt Romney’s Massachusetts health care law. However, it is a small step in the right direction and would have tragic consequences if legislatively overturned.

Most of the Affordable Care Act has yet to be put into full force and effect. Shouldn’t we at least try the new system before we conclude it is the worst thing that could possibly happen? If it proves itself to be ineffectual at helping to cure some of the issues with our current health system, then we re-examine the plan and make changes to it.

However, the preceding facts strongly support the thesis that we will not likely achieve a reduction in rising health care costs or better health care outcomes until we also have a predominately government-based health system.

Please, do not be deceived: As indicated by all relevant health care outcomes, our current for-profit health care system is one of the worst and the most expensive, as compared to most modern countries and to even some developing countries.

The evidence also indicates that the cure or the road to recovery for our ill health system, in both better health outcomes and reduced cost, will only happen when our system consists predominately of a government health plan.

Jesse Fuchs, Ph.D., is a professional demographer living in Slaughterville. Fuchs welcomes comments and request for sources at

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